A State-Level Analysis of Social and Structural Factors and HIV Outcomes Among Men Who Have Sex With Men in the United States

• Published in: AIDS education and prevention 2015-12, Vol.27 (6), p.493-504
• Main Authors: Forsyth, Andrew D, Valdiserri, Ronald O
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adult; AIDS; AIDS/HIV; Bisexuality; Bivariate analysis; Communicable Diseases; Cultural Context; Data Analysis; Demographics; Diagnosis; Disease transmission; Epidemics; Epidemiology; Gays & lesbians; Ghettos; Health; Health care policy; Health Promotion; Health Status Disparities; HIV; HIV Infections - epidemiology; HIV Infections - prevention & control; HIV Infections - transmission; Homosexuality; Homosexuality, Male - statistics & numerical data; Human immunodeficiency virus; Humans; Income; Income inequality; Individual Characteristics; Lesbianism; Male; Males; Medical Services; Men; Multivariate Analysis; Population growth; Residence Characteristics; Residential Patterns; Risk; Risk Factors; Risk Reduction Behavior; Risk-Taking; Sex; Sexual Behavior; Sexual Identity; Sexual Orientation; Sexually transmitted diseases; Sexually Transmitted Diseases - epidemiology; Social Capital; Social Determinants of Health; Social Environment; Social factors; Social Networks; Social Services; Socioeconomic Factors; Socioeconomics; State policy; Statistical analysis; Statistical inference; STD; Syphilis; Systems Approach; Transsexuality; United States - epidemiology
• ISSN: 0899-9546; 1943-2755
• DOI: 10.1521/aeap.2015.27.6.493

We apply a social determinants of health model to examine the association of select social and structural influences on AIDS diagnosis rates among men who have sex with men (MSM) in the U.S. states. Secondary data for key social and structural variables were acquired and analyzed. Standard descriptive and inferential statistics were used to examine bivariate and multivariate associations of selected social and structural variables with estimated rate of Stage 3 HIV infection (AIDS) per 100,000 MSM in 2010. We found that living in states with a higher demographic density of lesbian, gay, bisexual, and transgender persons is independently associated with lower AIDS diagnosis rates among MSM. In addition, we found that greater income inequality and higher syphilis rates among men were associated with greater AIDS diagnosis rates among MSM, which may be attributable to state policy environments that underinvest in social goods that benefit population health, and to the fact that ulcerative sexually-transmitted infections increase biological risk of HIV transmission and acquisition. To end the epidemic in the U.S., it will be critical to identify and address state-level social and structural factors that may be associated with adverse HIV outcomes for MSM.